How a med student changed the course of his education to focus on Indigenous health

This spring, Thomas Dymond, a medical student here at Queen’s, requested a change to the way that students do their upper year clerkships. He asked to complete his 4-month longitudinal integrated clerkship in the Indigenous community of Akwesasne, under the guidance of Dr. Ojistoh Horn, a Mohawk family physician.

Thomas, who is Mi’kmaq from the Bear River First Nation in Nova Scotia, hasn’t always found his path through medical school to be easy. Last year, he took time away from school because of stress, and began to feel uncertain about whether he would complete his MD degree.

During this time of uncertainty, Thomas, was in touch with Ann Deer. Ann works with Queen’s as an Indigenous Recruitment and Support Coordinator, and is from Akwesasne. She had met an Indigenous physician at a conference, who was also from Akwesasne. Ann encouraged Thomas to reach out to her.

The physician was Dr. Horn. Thomas connected with her and soon had arranged to do a 4-week elective, a precursor to clerkship, at Akwesasne. Dr. Horn is the sole full-time physician for Akwesasne, a community of more than 14,000 people which straddles the borders of Ontario, Quebec and New York state. She and other visiting physicians care for patients at a variety of clinics, on home visits and at a long-term care facility in the community Thomas spent a month working alongside her, and for the first time, felt like he had found his place in medicine. “The elective revitalized me mentally, physically, emotionally and spiritually,” he says. “I felt lifted up, like I was contributing, learning and engaging. I wasn’t just giving back, I was also getting something out of it.”

What distinguished Dr. Horn’s practice from Thomas’ previous exposure to medicine was her focus on the environmental impact of health. “She thinks outside the box,” says Thomas, “she knows what her patients have been exposed to, and makes connections between the environment, diet, lifestyle and health.” Thomas’ time at Awkesasne allowed him to get to know the customs and ways of life of a Mohawk community. He was embraced with open arms, and quickly formed relationships with others living on the reserve.

When his elective came to an end, Thomas knew he wanted to return.

With Dr. Horn’s support, Thomas drafted a letter to the Director of Clerkship and the Assistant Dean, Curriculum. His letter made a passionate case, detailing how he would meet all of the curricular requirements for his pediatrics, family medicine and psychiatry clerkship courses by spending his four-month integrated rotation in Akwesasne. He laid out a plan. “I wanted to go back to Akwesasne, but I also wanted to change clerkship, to change the system, to change medicine,” says Thomas.

After submitting the letter, Thomas was terrified. He knew that it was an atypical request, and was fully prepared for the school to say no.

Instead, his letter was acknowledged and passed along to Dr. Shayna Watson, Director of the Integrated and Family Medicine Clerkships. Dr. Watson was in immediate support of Thomas’ request. There were hurdles to be overcome in a short period of time – Thomas’ request was made only two months before his clerkship was to start – but she committed to making it happen. “That was the first time I was advocating where someone said ‘I will help you and take some of the weight off,’” says Thomas. Though he was relieved that Dr. Watson was taking on his cause, he remained apprehensive.

Dr. Watson kept in touch with Thomas over those two months, giving him updates on her progress. In the background, she was coordinating the logistics. “I had the support of the Eastern Regional Medical Education Program,” says Dr. Watson, “and Dr. Horn graciously hosted Dr. Robin Kennie and I to visit and learn about the community as we made the arrangements for the rotation.”

Just before his clerkship was set to start, Dr. Watson confirmed that Thomas’ request to go to Akwesasne and work with Dr. Horn had been approved. Thomas would be the first student in the School of Medicine to do his longitudinal integrated clerkship in an Indigenous community, under the supervision of an Indigenous physician, caring for Indigenous patients.

Thomas is now completing his clerkship rotation at Akwesasne, and he could not be happier. “I feel like I am fully supported for who I am,” says Thomas, “both an Indigenous person and a medical student.”

Thomas has worked hard to forge a path for other Indigenous students in the School of Medicine, and his clerkship has broken new ground. While he navigates the challenges of establishing a new clerkship, he is setting a path for others, and helping to build an important relationship between the School of Medicine and the community of Akwesasne.

“As we work to Indigenize the school of medicine’s curriculum, forming relationships with nearby Indigenous communities is a crucial step,” says Dr. Leslie Flynn, Vice Dean Education, Faculty of Health Sciences, “Thomas is an exceptional student, and I am thrilled that he took the initiative to make this happen. He has led the way to enhancing our community partnerships.”

While Thomas is immersed in his clerkship, he is also thinking ahead to residency. He is applying to orthopedics, with his sights set on maintaining a connection to Akwesasne.

“Perhaps one day,” he muses, “I could run a clinic there and provide orthopedic care to a population that doesn’t always have easy access to that type of care.”

Given the passion, drive and dedication that Thomas has demonstrated so far, I have no doubt that he will.

Please share your thoughts by commenting on the blog, or better yet, drop by the Macklem House, my door is always open.

Annette dymond

Seeing the results first hand by visiting the reserve and seeing our son engaging with the community was wonderful. To all those who have made it happen thank you for believing in our son as much as we do.

Shayna Watson

Annette, It has been a pleasure to work with your son and to help him to meet some of his goals. I appreciate the opportunity to learn along with him, and through him to have met Dr. Horn. We will all follow with interest as he continues on his path of learning and service.

Leslie Flynn

Thank you so much for your visit and for your comment, Annette. We do indeed believe in your son. He has provided leadership and direction to his peers, his teachers and our community during his time at Queen's School of Medicine. We are very proud of his accomplishments and his many contributions, and know that you share that pride with us. We look forward to following his future career, knowing that he will continue to make an impact.

Willa Henry

This is innovative and exciting and shows how far we have come in recognizing the importance of clinical context. This Indigenous student felt heard and understood. His advocacy is a first step in making a huge difference for the populations he will serve. So proud of the student and Queens!

Leslie Flynn

Thank you so much for weighing in on this important issue Willa. You bring a depth of experience regarding this topic given your previous leadership and clinical practice at Queen's and subsequently at the University of British Columbia. Your vote of confidence in our progress is sincerely appreciated.

Andrew Pipe, Meds '74

Congrats to Thomas for his initiative and to Drs. Horn and Ashton for ensuring that this innovative approach has moved forward! Another demonstration of the thoughtful, insightful leadership so evident in the Faculty of Health Sciences at Queen's.

Leslie Flynn

Thank you for your positive endorsement of Thomas, Drs. Horn and Ashton and this initiative to create a meaningful clerkship experience delivering care in an indigenous setting. We are excited about this and hope to see further indigenous initiatives created and supported in future for the FHS at Queen's. Your important role as the Chair of the Dean's Advancement Cabinet contributes significantly to our ability to pursue new paths. Sincere thanks.